Improve BP Control Research Articles

Primary Aldosteronism and Pregnancy

Objective: Primary aldosteronism (PA) may present at younger age and may thus complicate pregnancy. Our aim was to identify female patients in whom PA was diagnosed after pregnancy complicated with hypertension and to analyze possible hypertension-related complications during pregnancy. Methods: We performed retrospective analysis of female patients with PA diagnosed and treated at our Department who were pregnant before the diagnosis of PA. Results: We found 14 patients with PA (age at diagnosis 32.2 ± 4.2 years, hypertension duration 5.4 ± 3.6 years) suffering from hypertension 3 (IQR 0, 4) years before pregnancy (6 patients had hypertension diagnosed during pregnancy). Three subjects were pregnant twice, and 1 patient had been pregnant three times before the final diagnosis of PA was made. Ten subjects delivered by Caesarean section (in 3 cases due to early-onset preeclampsia and 2 subjects due to significantly increased blood pressure), and 9 cases spontaneously (1 subject complicated twice due to late-onset preeclampsia). Preterm delivery occurred in 5 cases – the earliest one in the sixth month of gestation. Subsequent diagnosis of PA (sometimes with a long delay up to a maximum of 12 years) was made on the basis of significantly low potassium values (2.7 ± 0.4 mmol/L; 2 subjects even suffered from muscle cramps) and hypertension (mostly moderate), elevated plasma/serum aldosterone (54.1 ± 20.2 ng/dL) and suppressed plasma renin activity (0.4 ± 0.2 ng/mL/h) or plasma renin (1.9 ± 1.6 ng/L). Thirteen subjects underwent laparoscopic adrenalectomy (in all but 2 cases, diagnosis of a large cortical adenoma [16 ± 5.9 mm] was made), and 1 subject was classified with bilateral hyperplasia according to adrenal venous sampling. Operation normalized BP in 10 subjects and improved BP control in the remaining 3 subjects. Two patients became pregnant after adrenalectomy, and their pregnancies were uneventful. Conclusion: PA is associated with a high rate of pregnancy-related complications. The most frequent complication is preeclampsia, in some cases leading to preterm delivery. The optimal prevention of these complications is early diagnosis of PA, and in these particular hypertensive cases, the awareness of hypokalemia.

Systolic and diastolic hypertension among patients on hemodialysis: Musings on volume overload, arterial stiffness, and erythropoietin.

Hypertension among patients on hemodialysis is predominantly systolic (either isolated or combined with diastolic hypertension), whereas the scenario of isolated diastolic hypertension is rare and more common in younger patients. Uncontrolled hypertension that persists despite aggressive antihypertensive drug therapy is a reflection of the volume overload that is a prominent mediator of systolic and diastolic BP elevation. Clinical-trial evidence supports the notion that dry-weight probing is an effective strategy to improve BP control, even when overt clinical signs and symptoms of volume overload are not present. Accelerated arterial stiffness influences the patterns and rhythms of interdialytic ambulatory BP and is a major determinant of isolated systolic hypertension in hemodialysis. Posthoc analyses of the Hypertension in Hemodialysis patients treated with Atenolol or Lisinopril (HDPAL) trial, however, suggest that arterial stiffness does not make hypertension more resistant to therapy and is unable to predict the treatment-induced improvement in left ventricular hypertrophy. A combined strategy of sodium restriction, dry-weight adjustment, and antihypertensive medication use was effective in improving ambulatory BP control regardless of the severity of underlying arteriosclerosis in HDPAL. Other nonvolume-dependent mechanisms, such as erythropoietin use, appear to be also important contributors and should be taken into consideration, particularly in younger hemodialysis patients with diastolic hypertension. In this article, we explore the role of volume overload, arterial stiffness, and erythropoietin use as causes of systolic vs diastolic hypertension in patients on hemodialysis. We conclude with clinical practice recommendations and with a call for a "volume-first" approach when managing hemodialysis hypertension.

Efficacy and safety of triple versus dual combination blood pressure-lowering drug therapy: a systematic review and meta-analysis of randomized controlled trials.

Most patients with hypertension need at least two drugs to achieve goal blood pressure. This systematic review assessed efficacy and safety of triple versus dual combination therapy for the management of hypertension. Publication databases, clinical trial registries and regulatory agency websites were searched until April 2018 for double-blind randomized controlled trials (RCTs) comparing triple with dual therapy of BP-lowering drugs, for at least 3 weeks, among patients with hypertension. Meta-analyses for efficacy and safety outcomes were performed using random-effects model. Regimen efficacy was predicted using the Therapeutic Intensity Score (TIS) and the Law et al. method (which predict dose doubling increases efficacy by 100% and around 20%, respectively), and compared with observed efficacy. Fourteen RCTs (11 457 participants) were included. Overall, triple compared with dual therapy reduced BP by 5.4/3.2 mmHg (P < 0.001), and improved BP control by 58 versus 45% [relative risk (RR) 1.33 (95% CI 1.25-1.41)], whereas incidence of withdrawals because of adverse events were 3.3 versus 3.4% [RR 1.24 (95% CI 1.00-1.54), P = 0.05]. Law et al.'s method was superior to TIS in predicting differences in efficacy between triple and dual therapies. For patients uncontrolled on submaximal dose dual therapy, adding a third drug achieved on average approximately four times more BP reduction than doubling the dose of dual therapy component drugs (6.0/3.6 versus 1.5/0.8 mmHg, respectively). Addition of a third drug is likely to be more efficacious without increasing adverse events, compared with increasing dose of existing dual therapy. Early use of triple therapy can significantly improve hypertension control.

In black Africans with hypertension, amlodipine-based therapy vs perindopril-hydrochlorothiazide improved BP control.

Source Citation Ojji DB, Mayosi B, Francis V, et al; CREOLE Study Investigators. Comparison of dual therapies for lowering blood pressure in black Africans. N Engl J Med. 2019. [Epub ahead of print...

Effectiveness of a community-based health programme on the blood pressure control, adherence and knowledge of adults with hypertension: A PRECEDE-PROCEED model approach.

To determine the effectiveness of a community-based health programme grounded on the PRECEDE-PROCEED model, on the knowledge, adherence and blood pressure control of community-dwelling adults with hypertension. Hypertension has consistently been a leading cause of morbidity and mortality in different countries and has continuously increased in prevalence. Albeit manageable with lifestyle modification and anti-hypertensive medications, adequate knowledge and poor adherence to these treatment regimens are issues that have led to poor blood pressure control. Quasi-experimental, one-group pretest-post-test design. The PRECEDE-PROCEED model was used to develop and evaluate the effectiveness of the community-based health programme. From August to October 2017, a total of 50 community-dwelling adults with hypertension participated in the programme which included blood pressure monitoring, targeted health educations, motivational interviews, individualised lifestyle modification plans and house-to-house visits. Knowledge, adherence and blood pressure were assessed at the start and at the end of the 2-month programme. Gathered data were analysed using descriptive statistics and RM-MANOVA. The TREND checklist was followed in reporting this study (See Appendix S1). After 2months, the mean adherence, systolic blood pressure and diastolic blood pressure significantly improved, attributing more than 25% of the change. Although knowledge scores were significantly higher after the programme, it only accounted 9% of the improvement. This study provides evidence on the effectiveness of a community-based health programme grounded on the PRECEDE-PROCEED model on the knowledge, adherence and blood pressure control of community-dwelling adults with hypertension. The community-based health programme is beneficial to community-dwelling adults with hypertension in promoting knowledge and adherence to treatment regimen and improving BP control. This study also provides a framework for developing new or enhancing existing programmes on hypertension in the Philippines.

Improving Hypertension Control in Primary Care With the Measure Accurately, Act Rapidly, and Partner With Patients Protocol.

Better blood pressure (BP; mm Hg) control is a pivotal national strategy for preventing cardiovascular events. Measure accurately, Act rapidly, and Partner with patients (MAP) with practice facilitation improved BP control (<140/<90 mm Hg) from 61.2% to 89.8% during a 6-month pilot study in one primary care clinic. Current study objectives included evaluating the 6-month MAP framework in 16 Family Medicine Clinics and then withdrawing practice facilitation and determining whether better hypertension control persisted at 12 months since short-term improvements often decline by 1 year. Measure accurately included staff training in attended (intake) BP measurement and unattended automated office BP when intake BP was ≥140/≥90 mm Hg. Act rapidly (therapeutic inertia) included protocol-guided escalation of antihypertensive medications when office BP was ≥140/≥90 mm Hg. Partner with patients (systolic BP decline/therapeutic intensification) included shared decision making, BP self-monitoring, and affordable medications. Study data were obtained from electronic records. In 16 787 hypertensive adults (mean, 61.2 years; 54.1% women; 46.0% Medicare) with visits at baseline and first 6 months, BP control improved from 64.4% at baseline to 74.3% ( P<0.001) at 6 and 73.6% ( P<0.001) at 12 months. At the first MAP visit, among adults with uncontrolled baseline BP and no medication changes (n=3654), measure accurately resulted in 11.1/5.1 mm Hg lower BP. During the first 6 months of MAP, therapeutic inertia fell (52.0% versus 49.5%; P=0.01), and systolic BP decreased more per therapeutic intensification (-5.4 to -12.7; P<0.001). MAP supports a key national strategy for cardiovascular disease prevention through rapid and sustained improvement in hypertension control, largely reflecting measuring accurately and partnering with patients.

A4214 The Rationale, Design, and Baseline Characteristics of BP-CONNECT

Objectives: Only 13.8% of 27 million hypertension patients controlled their BP in China. Although mhealth technology have been used in many health improvement context, rigorous evidence is still rarely seen. Practical and well-designed study is needed to evaluate the efficacy in patients with uncontrolled hypertension with modern mhealth technology. To determine whether an intervention that combines usual routine care, mHealth based home BP telemonitoring, patient case management with community health workers and virtual social media support improves BP control comparing with usual care plus normal BP telemonitoring at 6,12 and 18 months in patients with uncontrolled hypertension in primary care settings. Methods: The BP-CONNET study was designed as a community-based multi-center open-labeled randomized controlled comparative effectiveness trial conducted in Beijing China. Results: Between January 2017 and June 2017, BP-CONNET enrolled 601 hypertensive patients with uncontrolled BP from 19 community health centers. Three hundred and seven patients were randomized intervention group which provide mobile internet base home BP monitoring plus case management with community health worker and WeChat based virtual social media support. Two hundred and ninety-four were randomized to control group which provide usual care and normal BP telemonitoring. For the intervention group, physicians and community health workers collaborated through mobile internet based on the home BP data to provide BP case management services. The length of the intervention is 12 months, with follow-up to 18 months to determine the durability of the intervention. Conclusion: The results will provide important new evidence regarding effects of this intervention model in real world community clinic settings and primary care hypertensive population.

Abstract P367: Adherence Assessment Via Comprehensive Identification and Quantitation of Circulating Medications with Significant Correlation to Lower Blood Pressure Observed in Hypertensive Patients

Employing a novel and proprietary comprehensive precision medicine clinical tool that is a LC/MS/MS-based platform (PrecisCMQ™), we analyzed the serum of HTN patients seeking emergency care (n=293) for the presence and quantity of 42 antihypertensive and cardiovascular medications. Patient self-reported adherence correlated with clinical tool-based adherence. Among patients prescribed &gt; 3 medications, clinical tool-based adherence in patients (n=74) who indicate they never miss a dose was 74%, versus 60% in patients (n=69) who reported missed doses (p = 0.009, two-sided t-test; median prescribed medications = 3.5). Patients were considered adherent when 80% of prescribed medications were detected and categorized as nonadherent otherwise. Among patients with &gt; 3 prescribed medications, we found adherent patients had lower SBP (9.7 mm Hg; 95% CI 1.8 - 17.6; p = 0.02) and lower DBP (6.9 mm Hg; 95% CI 1.9 - 12.1; p = 0.007) after adjusting for age, sex, BMI, and patient-reported adherence. No significant difference in BP was observed in patients prescribed &lt; 3 medications. By comparing medication clinical tool-based detections to prescribed medications listed in the EHR, 12% of the detected medications (68/549) were not recorded in the patients’ EHR. After accounting for the above covariates and the number of medications in the EHR, we observed that the total number of detected medications, including prescriptions not in the EHR, significantly correlated with both SBP (attributed to 4.8% of variation; p = 0.01) and DBP (patients prescribed &gt; 3medications; explaining 2.5% of BP variation; p = 0.05). Additionally, to assess whether patients with higher systemic medication concentrations had lower BP, we compared SBP and DBP to medication concentrations normalized to published reference ranges. After accounting for the above covariates and the number of detected medications, we observed a relationship between medication(s) concentration(s) and BP across all patients. Together, these results support the utility of clinical tool-based medication monitoring for assessing adherence and improving BP control in HTN patients.

PCV69 - Real World Practice and Patient-Reported Outcomes of Uncontrolled Hypertensive Patients In Korea

This aimed to assess treatment patterns and medication adherence and to compare clinical(BP control) and Patient-Reported Outcomes(treatment satisfaction and quality of life, QoL) by treatment patterns and medication adherence at 6-month among uncontrolled hypertensive(HTN) patients of Korea. A prospective,observational,non-interventional study was conducted at 16 nationwide, tertiary hospitals. Uncontrolled HTN patients(SBP≥140mmHg or DBP≥90mmHg) were enrolled during 2015-2016 and studied for following 6-month. Data collection was performed through medical chart review and patient survey. Treatment patterns were used to examine whether physicians followed guideline-based practice(GBP) which was defined if one of followings was met;1)maximize first medication before adding second or 2)add second medication before reaching maximum dose of first medication. Medication adherence was investigated with Morisky Medication Adherence Scale-8(MMAS-8) with 3-level of adherence(high,medium,low) and patients were further categorized adherent if they showed high adherence. Treatment satisfaction was assessed using treatment satisfaction questionnaire for medication-1.4(TSQM 1.4) consisting of 4-domain(effectiveness,side-effects,convenience,global satisfaction).EuroQoL-Visual Analogue Scale(EQ-VAS) was used to examine QoL. A total of 600 patients included. Of the total, mean age was 58.6±13.4 and male were 55.7%. Portions of adherent patients and patients who received GBP were 49.2% and 67.4% at 6-month, respectively. Overall BP control rate was 34.6% and differed by GBP and adherence status at 6-month. Higher BP control rate was present in patients who were on GBP and also adherent than those on GBP, but not adherent, or non-GBP patients(76.8%vs.71.9%vs.53.6%, p-value<.0001). Better treatment satisfaction found in GBP and adherent patients comparing to GBP and non-adherent or non-GBP patients(effectiveness:66.5±12.0vs.62.4±13.6vs.61.4±12.6, side-effects:99.5±4.2vs.97.5±10.5vs.99.2±5.8, convenience:72.1±10.1vs.64.2±12.6vs.65.3±11.7, global satisfaction:65.7±12.1vs.60.7±14.3vs.59.1±13.7, all p-vales<0.05). For EQ-VAS, GBP and adherent patients showed better QoL than GBP with non-adherent or non-GBP patients(77.6±11.7vs.74.2±14.1vs.74.1±13.7, p<.0001). This highlights the importance of GBP and patient-reported adherence to improve BP control, treatment satisfaction, and QoL.

Risk profile, quality of life and care of patients with moderate and advanced CKD: The French CKD-REIN Cohort Study.

The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study was designed to investigate the determinants of prognosis and care of patients referred to nephrologists with moderate and advanced chronic kidney disease (CKD). We examined their baseline risk profile and experience. We collected bioclinical and patient-reported information from 3033 outpatients with CKD and estimated glomerular filtration rates (eGFRs) of 15-60 mL/min/1.73 m2 treated at 40 nationally representative public and private facilities. The patients' median age was 69 (60-76) years, 65% were men, their mean eGFR was 33 mL/min/1.73 m2, 43% had diabetes, 24% had a history of acute kidney injury (AKI) and 57% had uncontrolled blood pressure (BP; >140/90 mmHg). Men had worse risk profiles than women and were more likely to be past or current smokers (73% versus 34%) and have cardiovascular disease (59% versus 42%), albuminuria >30 mg/mmol (or proteinuria > 50) (40% versus 30%) (all P < 0.001) and a higher median risk of end-stage renal disease within 5 years, predicted by the kidney failure risk equation {12% [interquartile range (IQR) 3-37%] versus 9% [3-31%], P = 0.008}. During the previous year, 60% of patients reported one-to-two nephrologist visits and four or more general practitioner visits; only 25% saw a dietician and 75% were prescribed five or more medications daily. Physical and mental quality of life (QoL) were poor, with scores <50/100. The CKD-REIN study highlights high-risk profiles of cohort members and identifies several priorities, including improving BP control and dietary counselling and increasing doctors' awareness of AKI, polypharmacy and QoL. ClinicalTrials.gov identifier: NCT03381950.

The acute effect of continuous positive airway pressure titration on blood pressure in awake overweight/obese patients with obstructive sleep apnoea

Objectives: Continuous positive airway pressure (CPAP) improves upper airway obstruction in patients with obstructive sleep apnoea (OSA), who often are overweight-obese. Although it is thought that CPAP improves long-term blood pressure control (BP), the impact of acute and short-term CPAP use on the cardiovascular system in obese patients has not been described in detail.Methods: Obese patients (body mass index, BMI > 25 kg/m2) with OSA were studied awake, supine during incremental CPAP titration (4–20 cmH2O, +2 cmH2O/3 mins). BP was measured continuously with a beat-to-beat BP monitor (Ohmeda 2300, Finapres Medical Systems, Amsterdam/NL), BP variability (BPV) was calculated as the standard deviation of BP at each CPAP level, the 95% confidence interval (95%CI) was calculated and changes in BP and BPV were reported.Results: 15 patients (12 male, 48 ± 10) years, BMI 38.9 ± 5.8 kg/m2) were studied; the baseline BP was 131.0 ± 10.2/85.1 ± 9.1 mmHg. BP and BPV increased linearly with CPAP titration (systolic BP r = 0.960, p < .001; diastolic BP r = 0.961, p < .001; systolic BPV r = 0.662, p = .026; diastolic BPV r = 0.886, p < .001). The systolic BP increased by +17% (+23.15 (7.9, 38.4) mmHg; p = .011) and the diastolic BP by +23% (+18.27 (2.33, 34.21) mmHg; p = .009), when titrating CPAP to 20 cmH2O. Systolic BPV increased by +96% (+5.10 (0.67, 9.53) mmHg; p < .001) and was maximal at 14 cmH2O, and diastolic BPV by +97% (+3.02 (0.26, 5.78) mmHg; p < .001) at 16 cmH2O.Conclusion: Short-term incremental CPAP leads to significant increases in BP and BPV in obese patients with OSA while awake. Careful titration of pressures is required to minimise the risk of nocturnal awakenings while improving BP control.

Person-Centered Integrated Care for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The effectiveness of person-centered integrated care strategies for CKD is uncertain. We conducted a systematic review and meta-analysis of randomized, controlled trials to assess the effect of person-centered integrated care for CKD. We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (from inception to April of 2016), and selected randomized, controlled trials of person-centered integrated care interventions with a minimum follow-up of 3 months. Random-effects meta-analysis was used to assess the effect of person-centered integrated care. We included 14 eligible studies covering 4693 participants with a mean follow-up of 12 months. In moderate quality evidence, person-centered integrated care probably had no effect on all-cause mortality (relative risk [RR], 0.86; 95% confidence interval [95% CI], 0.68 to 1.08) or health-related quality of life (standardized mean difference, 0.02; 95% CI, -0.05 to 0.10). The effects on renal replacement therapy (RRT) (RR, 1.00; 95% CI, 0.65 to 1.55), serum creatinine levels (mean difference, 0.59 mg/dl; 95% CI, -0.38 to 0.36), and eGFR (mean difference, 1.51 ml/min per 1.73 m2; 95% CI, -3.25 to 6.27) were very uncertain. Quantitative analysis suggested that person-centered integrated care interventions may reduce all-cause hospitalization (RR, 0.38; 95% CI, 0.15 to 0.95) and improve BP control (RR, 1.20; 95% CI, 1.00 to 1.44), although the certainty of the evidence was very low. Person-centered integrated care may have little effect on mortality or quality of life. The effects on serum creatinine, eGFR, and RRT are uncertain, although person-centered integrated care may lead to fewer hospitalizations and improved BP control.

Abstract WP189: The Association of Blood Pressure Control with Belief of Self-Efficacy in Preventing Stroke

Background: Hypertension (HTN), including uncontrolled HTN, is one of the greatest contributors to stroke risk. A Risk Behavior Diagnosis Scale (RBD) was used to assess individual perceptions of stroke including efficacy for managing HTN associated with stroke risk. Methods: Data came from the 10-year risk factor telephone interview and in-home assessment of REGARDS participants. REGARDS is a national, population-based, longitudinal study of black and white adults ≥ 45 years, enrolled 2003-2007. Participants were asked about agreement with four constructs of RBD: response efficacy (controlling my BP is effective in preventing stroke), self-efficacy (having skills to control my BP to prevent stroke), severity (belief that stroke is extremely harmful), and susceptibility (it is likely I will have a stroke.) Analysis was restricted to 8,269 individuals with self-reported physician-diagnosis of HTN. BP control was defined as SBP &lt; 140 mmHg or DBP &lt; 90 mmHg. Logistic regression was used to examine the association of hypertension control with agreement with each construct, adjusting for demographics, socioeconomic factors, and history of previous stroke. Results: Of those who reported HTN, 6,799 (82%) had controlled HTN. In the multivariable model, control of BP was strongly associated with agreement with “having the skills to control BP to prevent stroke” (OR = 1.37; 95% CI: 1.13 - 1.66). There were no associations (p &gt; 0.05) between hypertension control and agreement with any other constructs (see table.) Conclusions: Among persons with self-reported HTN, those who agreed they had the skills to control their blood pressure to prevent stroke were more likely to have their hypertension controlled. Although self-efficacy is difficult to influence, strategies to improve skills and confidence related to BP management may improve BP control.

Pharmacotherapy of Hypertension in Chronic Dialysis Patients.

Among patients on dialysis, hypertension is highly prevalent and contributes to the high burden of cardiovascular morbidity and mortality. Strict volume control via sodium restriction and probing of dry weight are first-line approaches for the treatment of hypertension in this population; however, antihypertensive drug therapy is often needed to control BP. Few trials compare head-to-head the superiority of one antihypertensive drug class over another with respect to improving BP control or altering cardiovascular outcomes; accordingly, selection of the appropriate antihypertensive regimen should be individualized. To individualize therapy, consideration should be given to intra- and interdialytic pharmacokinetics, effect on cardiovascular reflexes, ability to treat comorbid illnesses, and adverse effect profile. β-Blockers followed by dihydropyridine calcium-channel blockers are our first- and second-line choices for antihypertensive drug use. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers seem to be reasonable third-line choices, because the evidence base to support their use in patients on dialysis is sparse. Add-on therapy with mineralocorticoid receptor antagonists in specific subgroups of patients on dialysis (i.e., those with severe congestive heart failure) seems to be another promising option in anticipation of the ongoing trials evaluating their efficacy and safety. Adequately powered, multicenter, randomized trials evaluating hard cardiovascular end points are urgently warranted to elucidate the comparative effectiveness of antihypertensive drug classes in patients on dialysis. In this review, we provide an overview of the randomized evidence on pharmacotherapy of hypertension in patients on dialysis, and we conclude with suggestions for future research to address critical gaps in this important area.

PP.08.24

Objective: Arterial hypertension phenotyping by plasma renin activity (PRA) may be a useful approach to improve BP control. Thus target organ damage evaluation is important in different types of arterial hypertension determined by PRA measurement. The aim of study was to compare left ventricular systolic function with speckle tracking technique in subjects with low-renin and renin-mediated hypertension Design and method: PRA (radioimmune assay) was measured in 72 hypertensive subjects (age 61,1 ± 7,6 years, 30 male). PRA < 0,65 ng/ml/h was classified as volume (V)-type hypertension, PRA > 0,65 ng/ml/h - as renin (R)-type. Longitudinal global systolic deformation (LGSD) was evaluated by 2-D echocardiography (normal < -18,6%) and compared in subjects with two types of hypertension. Multivariate regression analysis was applied to define determinants of LGSD. p < 0,05 was considered significant. Results: 42 (58%) subjects had V-type hypertension, 30 (42%) - R-type. Despite patients with V-type hypertension were older (respectively, 63,1 ± 9,1 vs 60,3 ± 6,4 years, p < 0,05) and had higher systolic and diastolic BP (162,6 ± 14,1/103,7 ± 11,5 vs 157,9 ± 17,1/95,0 ± 7,8 mmHg), respectively, p < 0,05). Left ventricular ejection fraction was similar in the two subgroups: 64,8 ± 5,9% in V-type, and 68,5 ± 7,0% in R-type. Despite of normal EF impairment of LGSD was found in 75% among all patients and was significantly higher in subjects with R-type hypertension than in V-type, respectively, 97% vs 40% (χ2 = 75,3; p < 0,001). Absolute LGSD values were, respectively, −16,6 ± 3,3 vs -17,9 ± 3,4% (p < 0,05). Multivariate regression analysis revealed independent association of PRA and LGSD (β = 1,94, p < 0,001). Conclusions: Evaluation of longitudinal global systolic deformation reveals systolic dysfunction in 75% hypertensive patients. Systolic function impairment is associated with renin-mediated arterial hypertension.

PCV16 - Efficacy And Safety Of Amlodipine And Bisoprolol In Hypertension Treatment: A Systematic Review

The complexity of therapy and pill burden has a direct impact on treatment compliance. Compliance is improved when agents are prescribed as fixed dose combinations rather than separate pills. This could be of particular value in elderly patients with multiple morbidities requiring polypharmacy. This systematic review aims to at evaluating efficacy and safety of the once-daily fixed-dose-combination (bisoprolol+amlodipine) on SAH. Electronic searches included MEDLINE, LILACS, EMBASE, CRD, among others until June 2014. Search terms included “Amlodipine”, “Bisoprolol” and “Hypertension” via MESH controlled vocabulary. Where included studies with information on patients using the combination for hypertension treatment. Two reviewers performed the search. From 704 articles found, 3 evaluated efficacy. Mean reduction of 19.7% in DBP, from 103.9±9.6 mmHg at baseline to 83.4±6.2 mmHg (p<0.0001). SBP decreased from 20.4% to 21,8% and DBP decreased19.7% to 21.2%. SBP/DBP goal (<140/90 mmHg) was reached or exceeded from 82.5 to 89.0% of patients by the end of 8 weeks. HR presented reductions from 10.4% to 21.65% to the end of 8 weeks (from 87.3 ± 11.07 bpm to 68.4 ± 8.13 bpm). Pedal edema was observed in 7.5% to 8%. Excellent/good tolerability was reported by 90.6% to 94% of patients. Combination therapy is likely to cause fewer AEs with lower doses. Benefits of fixed-dose include reduced pill burden, improved BP control, compliance and cost savings. Persistence rate of 58.3% compared to 14.9% and a compliance rate of 76.9% versus 54.4% were observed. Patients with HR >79 bpm had an 89% greater risk of mortality than those with HR ≤79 bpm. In summary, bisoprolol plus amlodipine in a fixed-dose combination showed to improve response rate, with a similar safety profile when compared with amlodipine and bisoprolol in monotherapy, potentially leading to an increase in SAH treatment compliance.

Hypertension control in a large multi-ethnic cohort in Amsterdam, The Netherlands: The HELIUS study

ObjectiveHypertension is a major problem among European ethnic minority groups. We assessed the current situation of hypertension prevalence and its management among a multi-ethnic population in Amsterdam, The Netherlands. MethodsData from the HELIUS study were used including 12,974 participants (1871 Ghanaian, 2184 African Surinamese, 2278 South-Asian Surinamese, 2277 Turkish, 2222 Moroccan and 2142 Dutch origin people), aged 18–70years. Comparisons among groups were made using proportions and age-adjusted prevalence ratios (PRs). ResultsHypertension prevalence ranged from 24% and 16% in Moroccan men and women to 52% and 62% in Ghanaian men and women. Except for Moroccan women, age-adjusted PR of hypertension was higher in all the ethnic minority groups than in Dutch. Among hypertensives, ethnic minority groups generally had higher levels of hypertension awareness and BP lowering treatment than Dutch. Moreover, prevalence rates for the prescription of more than one BP lowering drug were generally higher in African and South-Asian origin groups compared with Dutch origin people. By contrast, BP control levels were lower in all the ethnic groups than in Dutch, with control rates being significantly lower in Ghanaian men (26%, PR=0.49; 95% CI, 0.37–0.66) and women (45%, PR=0.64; 0.52–0.77), African-Surinamese men (30%, PR=0.61; 0.46–0.81) and women (45%, PR=0.72; 0.51–0.77), and South-Asian Surinamese men (43%, PR=0.77; 0.61–0.97) and women (47%, PR=0.76; 0.63–0.92) compared with Dutch men (53%) and women (61%). ConclusionOur findings indicate poor BP control in ethnic minority groups despite the high treatment levels. More work is needed to unravel the potential factors contributing to the poor control in order to improve BP control in ethnic minority groups, particularly among African and South-Asian origin groups.

Implementing Home Blood Pressure Monitoring Into Usual Care

Hypertension is a major public health issue in the United States with a high prevalence, increased burden in underserved populations, and suboptimal control. Home blood pressure monitoring (HBPM) has been demonstrated to improve BP control. The practice improvement project described in this study incorporates a culturally tailored HBPM program into primary care in a community health center. The outcomes demonstrate it is feasible to implement HBPM into primary care in an underserved, high-risk population and that control of BP was improved.

Proaterogenic metabolic disorders in patients with chronic kidney disease nondiabetic origin: possibility of statin therapy

PURPOSE AND MATERIAL: In order to study the state of coronary arteries, and dynamics of parameters of kidney function, lipid metabolism, levels of glycated hemoglobin (HbA1c), uricemia during administration of atorvastatin in a complex of standard cardioprotective treatment, we examined 54 patients with chronic kidney disease (CKD) of nondiabetic origin. All patients were divided in 2 groups: group I - 31 patients with glomerular filtration rate (GFR) <60 ml/min, who were additionally administered atorvastatin 20 mg/day; group II - 23 patients with glomerular filtration rate (GFR) more or equal 60 ml/min. On day 1 of hospitalization and after 6 months of treatment we determined levels of systolic and diastolic blood pressure (SBP and DBP), pulse pressure (PBP), lipid profile, uric acid levels, HbA1c and GFR (Cockcroft - Gault). Angiography of coronary arteries was also performed. It was found that three of four patients with CKD had coronary stenosis >50% in at least one coronary artery, combined with a substantial elevation of levels of atherogenic lipid fractions, HbA1c and uric acid. Administration of combination atorvastatin with standard treatment of CKD allowed to achieve significant reduction of levels of atherogenic lipid fractions, HbA1c, and uricemia, additional reductions in SBP and PBP by 4-5 mm Hg. Six-months therapy with statin was accompanied by 1.5 fold increase of GFR in patients with initial levels of GFR <60 ml/min. Thus, in patients with nondiabetic CKD statin therapy not only improved lipid metabolism, but also facilitated reduction of HbA1c and uricemia, improved BP control and functional ability of kidneys, especially in individuals with significant coronary artery stenosis.

The Counseling African Americans to Control Hypertension Study and Ways to Enhance the Next Wave of Behavioral Interventions

The Counseling African Americans to Control Hypertension (CAATCH) study by Ogedegbe et al in this issue of Circulation represents a carefully done study which had many strengths. It recognized that African Americans have the highest prevalence of hypertension (HTN)1 and that poor hypertension-related outcomes explain most of the racial gap in mortality between African Americans and whites.2 It represents the largest practice-based implementation trial to date of a multilevel evidence-based intervention targeted at blood pressure control in hypertensive African Americans in community health centers (CHCs), where many low income Americans receive their care. In addition, although the individual components of CAATCH (patient education, home BP monitoring, CME, physician chart audit and feedback) have proven efficacious and effective for improving BP control,3 the effectiveness of a combined approach in CHCs has not been rigorously evaluated. The study was adequately powered to detect a difference of at least 4 mmHg for systolic BP and 3 mm Hg for diastolic BP at 12 months between intervention and control arms assuming a 15% attrition rate.